- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.37 / $29.78 / $29.78
| Facility | 26 | $25.37 | $29.78 | $29.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.56 / $101.56 / $140.02
| Professional | | $101.56 | $101.56 | $140.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.39 / $21.07 / $22.32
| Professional | 26 | $19.39 | $21.07 | $22.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.05 / $119.42 / $245.98
| Professional | | $91.05 | $119.42 | $245.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.22 / $25.40 / $41.04
| Professional | 26 | $16.22 | $25.40 | $41.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.47 / $129.94 / $286.36
| Professional | | $89.47 | $129.94 | $286.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.87 / $27.51 / $54.42
| Professional | 26 | $18.87 | $27.51 | $54.42 |